Darin Trees, PT, DPT, CWS Moveo XP Beta Test Series

Case Study Guillain-Barr Syndrome

History
57 year-old male admitted to the emergency room with difficulty walking and numbness to the feet, diagnosed with Guillain-Barr Syndrome. The patient was moved to the ICU and placed on mechanical ventilation due to respiratory failure. He underwent five treatments of plasmaphoresis and required a tracheostomy for long-term mechanical ventilation. Physical therapy was consulted to begin rehabilitation. Patient was independent with all ADLs prior to admission.

PT Evaluation
General: Patient was mentally alert and could follow simple commands. Due to severe facial weakness, patient communicated by blinking for yes/no. Respiratory: Patient on ventilator in Assist Control mode. Strength: Bilateral UEs grossly 2/5. Hip and knee musculature grossly 2/5, ankle strength 0/5. Bed mobility, transfers: Dependent for rolling and supine-to-sit. Transfers not tested due to severe weakness. Sitting balance: Poor static and dynamic. Dependent to sit upright at edge of bed.

Treatment
Patient education included an in-bed exercise program, breathing exercises, progressive sitting, trunk control activities, and daily use of a dynamic tilt exercise platform to develop lower extremity partial weight-bearing (PWB) strength training. For the PWB workout, the patient performed three to four sets of 10 inclined squats with tolerable resistance. The first session started with approximately 15% body weight with the patient progressing to 55% body weight after two weeks. During this time, sitting balance improved from dependent to unsupported sitting at bedside. Sit-to-stand assessment showed that the patient was unable to support full body weight and required maximal assistance to stand. For this reason, PWB exercise on the platform was continued for lower extremity strengthening. The therapy treatments then alternated manual standing on one day with PWB exercise the following day. This regimen continued for one week, at which time the patient could stand with minimal assistance using a rolling walker for support. The exercise platform was then discontinued so the patient could focus on progressive standing and gait training with a walker for the next two weeks.

Discharge
The patient was discharged to home, walking with a rolling walker 300, independent with transfers and bed mobility. The patient required supervision for ascending and descending stairs. The patient followed up with outpatient PT to restore endurance and balance.

Patient dependent to sit upright.

Patient performs inclined squats independently at 25% body weight.

Patient progressed to inclined squats with 65% body weight. Weaned to trach collar during days. Patient able to stand with a rolling walker and minimal assistance. Exercise platform discontinued to focus on progressive standing and gait training.

Patient able to sit unsupported.

Patient requiring maximal assistance to stand upright. Dynamic tilt exercise platform continued.

Patient discharged at modified independent level for ambulation with a rolling walker 300. Patient can ascend/descend stairs with supervision.

2009 Encore Medical, L.P., and Affiliates 7011B 0209

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